PURPOSE: There is limited data on the prevalence of cirrhotic cardiomyopathy, defined as systolic and diastolic dysfunction secondary to cirrhosis. Our purpose was to evaluate the prevalence of left atrial dilatation (LAD) and diastolic dysfunction (DD) in patients with hepatic hydrothorax (HH).
METHODS: From our thoracentesis database (2001-2008), we identified 41 consecutive cases of HH. Echocardiography was available for 37 (90%) cases.
RESULTS: Median age was 52 (22-78) years. 54% were male. Two thirds had biopsy proven cirrhosis. Pleural effusions were right sided in 24 (59%), left sided in 7 (17%) and bilateral in 10 (24%). Median ejection fraction was 60% (50-79). DD was present in 11 (52%) of 21 cases. LAD (> 4cm) was present in 23 (66%) of 35 cases; 9 (39%) of these had concurrent DD. 7 (64%) with DD and 11 (48%) with LAD had a history of hypertension. Intrapulmonary shunting was identified in 18 (78%) of 23 cases. Median right ventricular systolic pressure (n= 15) was 37mm Hg (26-72). The median BNP (n=11) was 114 pg/mL (24-388), and 5 (45%) had normal BNP (less than 100pg/mL). 25 (71%) had either LAD or DD; 7 (28%) of these had a history of hypertension, while 5 (20%) were being treated for hypertension. 13 (52%) had either LAD or DD without a history of hypertension.
CONCLUSION: Impaired cardiac function in cirrhosis is recognized more frequently by echocardiography. The precise pathophysiology of this entity remains unclear. Our study shows a high prevalence of DD and LAD in patients with HH independent of history of systemic hypertension. Systolic dysfunction is uncommon in this select population of end-stage liver disease.
CLINICAL IMPLICATIONS: Echocardiographic findings of DD or LAD are common in HH, and should not dissuade the clinician from diagnosing HH.
DISCLOSURE: Puncho Gurung, No Financial Disclosure Information; No Product/Research Disclosure Information